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General NPI Number Information
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NPI Number | 1700209905
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Entity Type | Individual
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Provider Name | ROBERT W WYATT
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Gender | Male
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Dates
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Enumeration Date | 01/24/2014
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 203 CEDAR SPRINGS RD
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City | SPARTANBURG
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State | SC
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Zip | 29302
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Country | US
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Telephone | 864-381-6366
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Fax | 864-381-6367
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Provider Business Mailing Address
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Address Line | 203 CEDAR SPRINGS RD
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City | SPARTANBURG
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State | SC
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Zip | 29302-4639
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Country | US
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Telephone | 864-381-6366
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Fax | 864-381-6367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5949
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License Number State | SC
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